Projects

Open Knowledge: Changing the Global Course of Knowledge, Stanford University

Open source, open science, open data, open access, open education, open learning -- this free, online course provides an introduction to the important concept of openness from a variety of perspectives, including education, publishing, librarianship, economics, politics, and more, and asks you to discover what it means to you. Open Knowledge is international and multi-institutional, bringing together instructors and students from Canada, Ghana, Mexico, the United States, and the rest of the world.

As a bilingual course, we include aGoogle Translate button to make the interface available in Spanish (and other languages), have linked to Spanish translations for many of the English language videos, added Spanish language materials where available, and welcome student suggestions for additional non-English resources for inclusion in the crowdsourced curriculum.

The course provided learners with the opportunity to connect with colleagues from different countries and professions, and to better understand areas where their interests overlap and where unexpected distinctions exist.

Location

stanford

For More Information:

In collaboration with faculty at the Stanford School of Education study the hypothesis that providing health personnel with relatively complete access to research (as the eventual result of the NIH Policy) leads to greater use, over time, of research evidence for the purposes of professional practice and learning. Funded by the National Science Foundation.

Location

stanford

Evidence Based Medicine in Education, University of Utrecht / University of California, San Francisco

My doctoral research examines physicians’ need for and use of information in clinical care and the ways in which evidence-based medicine (EBM) education is conducted. The goal of my research is to apply these and related findings to improving the design and implementation of EBM education.

Location

Participate in Medical Education Partnership Initiative based in Zimbabwe in relation to curriculum design, technology implementation, information resource training, evidence based medicine and faculty development. Funded by National Institute of Health.

Abstract

Physicians have many information needs that arise at the point of care yet go unmet for a variety of reasons, including uncertainty about which information resources to select. In this study, we aimed to identify the various types of physician information needs and how these needs relate to physicians' use of the database PubMed and the evidence summary tool UpToDate. We conducted semi-structured interviews with physicians (Stanford University, United States; n = 13; and University Medical Center Utrecht, the Netherlands; n = 9), eliciting participants' descriptions of their information needs and related use of PubMed and/or UpToDate. Using thematic analysis, we identified six information needs: refreshing, confirming, logistics, teaching, idea generating and personal learning. Participants from both institutions similarly described their information needs and selection of resources. The identification of these six information needs and their relation to PubMed and UpToDate expands upon previously identified physician information needs and may be useful to medical educators designing evidence-based practice training for physicians.

How are medical students trained to locate biomedical information to practice evidence-based medicine? a review of the 2007-2012 literature.Journal of the Medical Library Association Maggio, L. A., Kung, J. Y.2014; 102 (3): 184-191

Abstract

This study describes how information retrieval skills are taught in evidence-based medicine (EBM) at the undergraduate medical education (UGME) level.The authors systematically searched MEDLINE, Scopus, Educational Resource Information Center, Web of Science, and Evidence-Based Medicine Reviews for English-language articles published between 2007 and 2012 describing information retrieval training to support EBM. Data on learning environment, frequency of training, learner characteristics, resources and information skills taught, teaching modalities, and instructor roles were compiled and analyzed.Twelve studies were identified for analysis. Studies were set in the United States (9), Australia (1), the Czech Republic (1), and Iran (1). Most trainings (7) featured multiple sessions with trainings offered to preclinical students (5) and clinical students (6). A single study described a longitudinal training experience. A variety of information resources were introduced, including PubMed, DynaMed, UpToDate, and AccessMedicine. The majority of the interventions (10) were classified as interactive teaching sessions in classroom settings. Librarians played major and collaborative roles with physicians in teaching and designing training. Unfortunately, few studies provided details of information skills activities or evaluations, making them difficult to evaluate and replicate.This study reviewed the literature and characterized how EBM search skills are taught in UGME. Details are provided on learning environment, frequency of training, level of learners, resources and skills trained, and instructor roles.The results suggest a number of steps that librarians can take to improve information skills training including using a longitudinal approach, integrating consumer health resources, and developing robust assessments.

Abstract

The objective was to critically appraise and highlight medical education research published in 2012 that was methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM).A search of the English language literature in 2012 querying Education Resources Information Center (ERIC), PsychInfo, PubMed, and Scopus identified EM studies using hypothesis-testing or observational investigations of educational interventions. Two reviewers independently screened all of the publications and removed articles using established exclusion criteria. This year, publications limited to a single-site survey design that measured satisfaction or self-assessment on unvalidated instruments were not formally reviewed. Six reviewers then independently ranked all remaining publications using one of two scoring systems depending on whether the study methodology was primarily qualitative or quantitative. Each scoring system had nine criteria, including four related to methodology, that were chosen a priori, to standardize evaluation by reviewers. The quantitative study scoring system was used previously to appraise medical education published annually in 2008 through 2011, while a separate, new qualitative study scoring system was derived and implemented consisting of parallel metrics.Forty-eight medical education research papers met the a priori criteria for inclusion, and 33 (30 quantitative and three qualitative studies) were reviewed. Seven quantitative and two qualitative studies met the criteria for inclusion as exemplary and are summarized in this article.This critical appraisal series aims to promote superior education research by reviewing and highlighting nine of the 48 major education research studies with relevance to EM published in 2012. Current trends and common methodologic pitfalls in the 2012 papers are noted.

Abstract

Abstract Background: Increasing intensivist shortages and demand coupled with the escalating cost of care have created enthusiasm for intensive care unit (ICU)-based telemedicine ("tele-ICU"). This systematic literature review compares the Centralized Monitoring and Virtual Consultant tele-ICU Models. Materials and Methods: With an experienced medical reference librarian, we identified all language publications addressing the employment and efficacy of the centralized monitoring and virtual consultant tele-ICU systems through PubMed, CINAHL, and Web of Science. We performed quantitative and qualitative reviews of documents regarding financial sustainability, clinical outcomes, and ICU staff workflow and acceptance. Results: Of 1,468 documents identified, 1,371 documents were excluded, with the remaining 91 documents addressing clinical outcomes (46 documents [enhanced guideline compliance, 5; mortality and length of stay, 28; and feasibility, 13]), financial sustainability (9 documents), and ICU staff workflow and acceptance (36 documents). Quantitative review showed that studies evaluating the Centralized Monitoring Model were twice as frequent, with a mean of 4,891 patients in an average of six ICUs; Virtual Consultant Model studies enrolled a mean of 372 patients in an average of one ICU. Ninety-two percent of feasibility studies evaluated the Virtual Consultant Model, of which 50% were in the last 3 years. Qualitative review largely confirmed findings in previous studies of centralized monitoring systems. Both the Centralized Monitoring and Virtual Consultant Models showed clinical practice adherence improvement. Although definitive evaluation was not possible given lack of data, the Virtual Consultant Model generally indicated lean absolute cost profile in contrast to centralized monitoring systems. Conclusions: Compared with the Virtual Consultant tele-ICU Model, studies addressing the Centralized Monitoring Model of tele-ICU care were greater in quantity and sample size, with qualitative conclusions of clinical outcomes, staff satisfaction and workload, and financial sustainability largely consistent with past systematic reviews. Attention should be focused on performing more high-quality studies to allow for equitable comparisons between both models.

Abstract

The research sought to ascertain the types and quantity of research evidence accessed by health personnel through PubMed and UpToDate in a university medical center over the course of a year in order to better estimate the impact that increasing levels of open access to biomedical research can be expected to have on clinical practice in the years ahead.Web log data were gathered from the 5,042 health personnel working in the Stanford University Hospitals (SUH) during 2011. Data were analyzed for access to the primary literature (abstracts and full-text) through PubMed and UpToDate and to the secondary literature, represented by UpToDate (research summaries), to establish the frequency and nature of literature consulted.In 2011, SUH health personnel accessed 81,851 primary literature articles and visited UpToDate 110,336 times. Almost a third of the articles (24,529) accessed were reviews. Twenty percent (16,187) of the articles viewed were published in 2011.When it is available, health personnel in a clinical care setting frequently access the primary literature. While further studies are needed, this preliminary finding speaks to the value of the National Institutes of Health public access policy and the need for medical librarians and educators to prepare health personnel for increasing public access to medical research.

Abstract

The objective was to critically appraise and highlight medical education research studies published in 2011 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM).A search of the English language literature in 2011 querying PubMed, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified EM studies that used hypothesis-testing or observational investigations of educational interventions. Six reviewers independently ranked all publications based on 10 criteria, including four related to methodology, that were chosen a priori to standardize evaluation by reviewers. This method was used previously to appraise medical education published in 2008, 2009, and 2010.Forty-eight educational research papers were identified. Comparing the literature of 2011 to that of 2008 through 2010, the number of published educational research papers meeting the criteria increased over time from 30, to 36, to 41, and now to 48. Five medical education research studies met the a priori criteria for inclusion as exemplary and are reviewed and summarized in this article. The number of funded studies remained fairly stable over the past 3 years, at 13 (2008), 16 (2009), 9 (2010), and 13 (2011). As in past years, research involving the use of technology accounted for almost half (n = 22) of the publications. Observational study designs accounted for 28 of the papers, while nine studies featured an experimental design.Forty-eight EM educational studies published in 2011 and meeting the criteria were identified. This critical appraisal reviews and highlights five studies that met a priori quality indicators. Current trends and common methodologic pitfalls in the 2011 papers are noted.

Abstract

The research explored the roles of practicing clinical librarians embedded in a patient care team.Six clinical librarians from Canada and one from the United States were interviewed to elicit detailed descriptions of their clinical roles and responsibilities and the context in which these were performed.Participants were embedded in a wide range of clinical service areas, working with a diverse complement of health professionals. As clinical librarians, participants wore many hats, including expert searcher, teacher, content manager, and patient advocate. Unique aspects of how these roles played out included a sense of urgency surrounding searching activities, the broad dissemination of responses to clinical questions, and leverage of the roles of expert searcher, teacher, and content manager to advocate for patients.Detailed role descriptions of clinical librarians embedded in patient care teams suggest possible new practices for existing clinical librarians, provide direction for training new librarians working in patient care environments, and raise awareness of the clinical librarian specialty among current and budding health information professionals.

Abstract

The medical education literature is growing, and the result is not only greater knowledge, but an increasing complexity in locating quality evidence-based information. In 2008, eight librarians partnered with the Association of American Medical Colleges to research, conceptualize, and build an online module to develop medical educators' search skills. Developing an online instructional module is a time-consuming, multi-stage process requiring the expertise of content, technical, and design specialists working in concert. Many lessons were learned, including the power of collaborative tools; the benefits of including specialists, such as graphic designers; the benefit of thoroughly surveying existing resources; and the importance of choosing technology wisely.

Abstract

The objective was to critically appraise and highlight medical education research studies published in 2010 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM).A search of the English language literature in 2010 querying PubMed, Scopus, Education Resources Information Center (ERIC), and PsychInfo identified 41 EM studies that used hypothesis-testing or observational investigations of educational interventions. Five reviewers independently ranked all publications based on 10 criteria, including four related to methodology, that were chosen a priori to standardize evaluation by reviewers. This method was used previously to appraise medical education published in 2008 and 2009.Five medical education research studies met the a priori criteria for inclusion and are reviewed and summarized here. Comparing the literature of 2010 to 2008 and 2009, the number of published educational research papers increased from 30 to 36 and then to 41. The number of funded studies remained fairly stable over the past 3 years at 13 (2008), 16 (2009), and 9 (2010). As in past years, research involving the use of technology accounted for a significant number of publications (34%), including three of the five highlighted studies.Forty-one EM educational studies published in 2010 were identified. This critical appraisal reviews and highlights five studies that met a priori quality indicators. Current trends and common methodologic pitfalls in the 2010 papers are noted.

Public Access and Use of Health Research: An Exploratory Study of the National Institutes of Health (NIH) Public Access Policy Using Interviews and Surveys of Health PersonnelJOURNAL OF MEDICAL INTERNET RESEARCHO'Keeffe, J., Willinsky, J., Maggio, L.2011; 13 (4)

Abstract

In 2008, the National Institutes of Health (NIH) Public Access Policy mandated open access for publications resulting from NIH funding (following a 12-month embargo). The large increase in access to research that will take place in the years to come has potential implications for evidence-based practice (EBP) and lifelong learning for health personnel.This study assesses health personnel's current use of research to establish whether grounds exist for expecting, preparing for, and further measuring the impact of the NIH Public Access Policy on health care quality and outcomes in light of time constraints and existing information resources.In all, 14 interviews and 90 surveys of health personnel were conducted at a community-based clinic and an independent teaching hospital in 2010. Health personnel were asked about the research sources they consulted and the frequency with which they consulted these sources, as well as motivation and search strategies used to locate articles, perceived level of access to research, and knowledge of the NIH Public Access Policy.In terms of current access to health information, 65% (57/88) of the health personnel reported being satisfied, while 32% (28/88) reported feeling underserved. Among the sources health personnel reported that they relied upon and consulted weekly, 83% (73/88) reported turning to colleagues, 77% (67/87) reported using synthesized information resources (eg, UpToDate and Cochrane Systematic Reviews), while 32% (28/88) reported that they consulted primary research literature. The dominant resources health personnel consulted when actively searching for health information were Google and Wikipedia, while 27% (24/89) reported using PubMed weekly. The most prevalent reason given for accessing research on a weekly basis, reported by 35% (31/88) of survey respondents, was to help a specific patient, while 31% (26/84) were motivated by general interest in research.The results provide grounds for expecting the NIH Public Access Policy to have a positive impact on EBP and health care more generally given that between a quarter and a third of participants in this study (1) frequently accessed research literature, (2) expressed an interest in having greater access, and (3) were aware of the policy and expect it to have an impact on their accessing research literature in the future. Results also indicate the value of promoting a greater awareness of the NIH policy, providing training and education in the location and use of the literature, and continuing improvements in the organization of biomedical research for health personnel use.

Abstract

Medical education literature has been found to lack key components of scientific reporting, including adequate descriptions of literature searches, thus preventing medical educators from replicating and building on previous scholarship. The purpose of this study was to examine the reproducibility of search strategies as reported in medical education literature reviews.The authors searched for and identified literature reviews published in 2009 in Academic Medicine, Teaching and Learning in Medicine, and Medical Education. They searched for citations whose titles included the words "meta-analysis," "systematic literature review," "systematic review," or "literature review," or whose publication type MEDLINE listed as "meta-analysis" or "review." The authors created a checklist to identify key characteristics of literature searches and of literature search reporting within the full text of the reviews. The authors deemed searches reproducible only if the review reported both a search date and Boolean operators.Of the 34 reviews meeting the inclusion criteria, 19 (56%) explicitly described a literature search and mentioned MEDLINE; however, only 14 (41%) also mentioned searches of nonmedical databases. Eighteen reviews (53%) listed search terms, but only 6 (18%) listed Medical Subject Headings, and only 2 (6%) mentioned Boolean operators. Fifteen (44%) noted the use of limits. None of the reviews included reproducible searches.According to this analysis, literature search strategies in medical education reviews are highly variable and generally not reproducible. The authors provide recommendations to facilitate future high-quality, transparent, and reproducible literature searches.

Abstract

The objective was to critically appraise and highlight methodologically superior medical education research specific to emergency medicine (EM) published in 2009.A search of the English language literature in 2009 querying Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE 1950 to Present, Web of Science, Education Resources Information Center (ERIC), and PsychInfo identified 36 EM studies that used hypothesis-testing or observational investigations of educational interventions. Six reviewers independently ranked all publications based on 10 criteria, including four related to methodology, that were chosen a priori to standardize evaluation by reviewers. This was a refinement of the methods used to appraise medical education published in 2008.Seven studies met the standards as determined by the averaged rankings and are highlighted and summarized here. This year, 16 of 36 (44%) identified studies had funding, compared to 11 of 30 (36%) identified last year; five of seven (71%) highlighted publications were funded in 2009 compared to three of five (60%) highlighted in 2008. Use of technology in medical education was reported in 14 identified and four highlighted publications, with simulation being the most common technology studied. Five of the seven (71%) featured publications used a quasi-experimental or experimental design, one was observational, and one was qualitative. Practice management topics, including patient safety, efficiency, and revenue generation, were examined in seven reviewed studies.Thirty-six medical education publications published in 2009 focusing on EM were identified. This critical appraisal reviews and highlights seven studies that met a priori quality indicators. Current trends are noted.

Clinical inquiries. How should you manage children born to hepatitis C-positive women?journal of family practicePowell, M., Bailey, J., Maggio, L. A.2010; 59 (5): 289-290

Abstract

For starters, don't be overly concerned with the mode of delivery; it does not influence the rate of transmission of hepatitis C virus (HCV), except in women who are also infected with human immunodeficiency virus (HIV). Avoid internal fetal monitoring and prolonged rupture of membranes. Advise patients that it is OK to breastfeed. Breastfeeding does not affect transmission. Check HCV RNA and serum anti-HCV on 2 occasions between 2 and 6 months of age and 18 and 24 months of age.

Abstract

As the definition of scholarship is clarified, each specialty should develop a cadre of medical education researchers who can design, test, and optimize educational interventions. In 2004, the Association for American Medical Colleges' Group on Educational Affairs developed the Medical Education Research Certificate (MERC) program to provide a curriculum to help medical educators acquire or enhance skills in medical education research, to promote effective collaboration with seasoned researchers, and to create better consumers of medical education scholarship. MERC courses are offered to individuals during educational meetings. Educational leaders in emergency medicine (EM) identified a disparity between the "scholarship of teaching" and medical education research skills, and they collaborated with the MERC steering committee to develop a mentored faculty development program in medical education research. A planning committee comprising experienced medical education researchers who are also board-certified, full-time EM faculty members designed a novel approach to the MERC curriculum: a mentored team approach to learning, grounded in collaborative medical education research projects. The planning committee identified areas of research interest among participants and formed working groups to collaborate on research projects during standard MERC workshops. Rather than focusing on individual questions during the course, each mentored group identified a single study hypothesis. After completing the first three workshops, group members worked under their mentors' guidance on their multiinstitutional research projects. The expected benefits of this approach to MERC include establishing a research community network, creating projects whose enrollments offer a multiinstitutional dimension, and developing a cadre of trained education researchers in EM.

Clinical inquiries. What's best when a patient doesn't respond to the maximum dose of an antidepressant?journal of family practiceLo, V., Maggio, L.2010; 59 (3): 173-175

Abstract

First, consider possible causes of the inadequate response to an antidepressant, then weigh treatment options in light of the characteristics of the individual patient and therapy. When managing a patient with nonpsychotic depression and inadequate response to the maximum dose of a single antidepressant, the physician should first identify factors that may contribute to the poor response, such as suboptimal dosage resulting from nonadherence, inadequate duration of therapy, and comorbid medical and psychiatric conditions. The literature supports several treatment alternatives, including augmentation with cognitive therapy, switch therapy, and combination-augmentation therapy; not enough studies exist to recommend the best treatment. All options reviewed produced a 20% to 50% remission rate. Physicians should consider the patient's clinical history and preferences, along with drug toxicity, potential drug interactions, and cost when making treatment decisions.

Abstract

Listeria monocytogenes is a food-borne pathogen that primarily affects pregnant women. Cardiac involvement is an uncommon complication of infection. We present a case of a gravida with Listeria bacteremia at 36 weeks of gestation.Two of a patient's blood cultures grew L monocytogenes after she experienced chills, headache, myalgia, and diarrhea. The patient was treated with antibiotics for 48 hours, and then labor was induced, resulting in a normal delivery with a healthy neonate. On day 5 postpartum, the patient developed progressive heart block, resulting in a third-degree block, which required a pacemaker. An electrocardiogram done 30 days after hospital discharge demonstrated an atrial-sensed, ventricularly paced rhythm, which indicated that the heart block had not resolved.Heart block is a rarely reported and possibly overlooked complication of listeriosis. Mothers with listerial infection should be screened for cardiac complications to avoid unexpected decompensation.

Abstract

In exploring new ways of teaching students how to use Medical Subject Headings (MeSH), librarians at Boston University's Alumni Medical Library (AML) integrated social tagging into their instruction. These activities were incorporated into the two-credit graduate course, "GMS MS 640: Introduction to Biomedical Information," required for all students in the graduate medical science program. Hands-on assignments and in-class exercises enabled librarians to present MeSH and the concept of a controlled vocabulary in a familiar and relevant context for the course's Generation Y student population and provided students the opportunity to actively participate in creating their education. At the conclusion of these activities, students were surveyed regarding the clarity of the presentation of the MeSH vocabulary. Analysis of survey responses indicated that 46% found the concept of MeSH to be the clearest concept presented in the in-class intervention.

Abstract

Librarians at the Boston University Medical Center constructed two interactive online tutorials, "Introduction to EBM" and "Formulating a Clinical Question (PICO)," for a Family Medicine Clerkship and then quickly repurposed the existing tutorials to support an Evidence-based Dentistry course. Adobe's ColdFusion software was used to populate the tutorials with course-specific content based on the URL used to enter each tutorial, and a MySQL database was used to collect student input. Student responses were viewable immediately by course faculty on a password-protected Web site. The tutorials ensured that all students received the same baseline training and allowed librarians to tailor a subsequent library skills workshop to student tutorial answers. The tutorials were well-received by the medical and dental schools and have been added to mandatory first-year Evidence-based Medicine (EBM) and Evidence-based Dentistry (EBD) courses, meaning that every medical and dental student at BUMC will be expected to complete these tutorials.